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Please fill out all the required fields on this form.  Once the form is signed you will be sent an email containg this form.  

You may print this form and bring it to the OHVA outing.  Or upon check in, you may show your completion email from a mobile device to verify you have completed this.  This waiver is valid for all OHVA events/outings during the 19-20 school year.  

Date: July 2, 2025

First Participants Name
First Name*
Middle Name
Last Name*
Phone*
First Participants Date of Birth*
Date of Birth
First Participants Signature*
Second Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Third Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Fourth Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Fifth Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Sixth Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Seventh Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Eighth Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Ninth Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Tenth Participants Name
First Name*
Middle Name
Last Name*
Participants Date of Birth*
Date of Birth
Parent or Learning Coach Email Address
Email*
Confirm Email*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Student ID #:
Student 1 *
Student 2
Student 3
Student 4
Student 5
Name of Outing
Name of Outing *
Date of Outing *
In case of an emergency, and I am not available, the OHVA staff has my permission to secure medical attention for my child.
Yes
No
Please note any special medical conditions: drug allergies, diabetes, food allergies, etc
I give permission for my child to be photographed while on the outing, and for photos to be used in school newsletters or publications.
Yes
No
If injuries are incurred by my student or myself, I will not hold Ohio Virtual Academy, school staff or volunteers liable, and understand it is my responsibility to supervise my child(ren) during a school event.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Learning Coach Name
First Name*
Middle Name
Last Name*
Phone*
Parent or Learning Coach Date of Birth*
Date of Birth
Parent or Learning Coach Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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